Pitfalls

Fluid and electrolyte imbalance

The risk of fluid and electrolyte imbalance is minimised by the use of oral hydration if possible. If IV rehydration is needed, the use of isotonic fluids, careful monitoring and adjustment of infusions is required.

Hypernatraemic dehydration

Hypernatraemic dehydration should be considered in those with suggestive clinical features. Baseline U&Es should be performed if there is concern. The risk of cerebral oedema can be minimised by slow rehydration (ideally with oral fluids) and careful monitoring of serum sodium levels.

Public health considerations

Parents and carers should be advised how to prevent spread of the infection:

• Washing hands in warm, soapy water after going to the toilet, changing nappies and preparing, serving or eating food
• Towels used by the infected child should not be shared
• The child should not return to school (or childcare facility) until asymptomatic for 48 hours
• The child should not swim in a public pool until asymptomatic for 2 weeks
• Notify and act on the advice of the public health authorities if you suspect an outbreak of gastroenteritis

Documentation

As with all critically ill patients, ensure notes are:

• Timed (24 hour clock) and dated
• Legible, accurate, sufficiently detailed and contemporaneous as possible
• Signed with name, designation and GMC number against their signature
• Complete with regards to discussions with senior colleagues and that the advice given is clearly documented.